Delirium, Dementia and Other Cognitive Disorders | Anatomy2Medicine
Delirium, Dementia and Other Cognitive Disorders

Delirium, Dementia and Other Cognitive Disorders

 

  • Disorders are characterized by an impairment in cognition
  • Amnestic Disorder
  • Delirium
  • Dementia
  • Features of delirium,
  • Acute onset

 

      • Clouding of Consciousness
      • Disorientation
      • Anterograde amnesia
      • Hallucinations, which are commonly visual.

 

  • Disturbed sleep-wake cycle.

 

      • Diurnal variations in symptoms, in which symptoms worsen during evening and night
    • Delirium may occur in
      • Epilepsy and Post-ictal states
      • Hepatic encephalopathy
      • Carbon dioxide narcosis
    • Nutrients’ deficiency that may result in delirium,

 

  • Vitamin B12
  • Thiamine
  • FolicAcid

 

    • Drugs that can produce delirium,
      • Alcohol
      • Reserpine
      • Trihexyphenydil
    • Delirium
      • Anxiety, insomnia, restlessness may precede the development of delirium.
      • Reduced ability to focus, sustain, or shift attention may be present
      • Consciousness may be impaired
      • Patients with delirium related to substance withdrawal    often have the hyperactive delirium.
    • Differentiate delirium versus dementia ( High yield MCQ in PG Medical entrance )
      • A patient with delirium may have episodes of decreased consciousness
      • The cognitive impairment in delirium may fluctuate over`the course of day
      • Perceptual abnormalities are more common in delirium as compared to dementia
      • Onset of delirium is sudden, whereas that of dementia is usually insidious
    • Delirium and Amnestic reaction may be seen with Alcohol
    • Delirium trimens is characterized by confusion and autonomic hyperactivity and tremors
    • Illusion with loss of consciousness is seen in Delirium
    • Visual hallucinations without auditory hallucinations are suggestive of Organic Brain damage
    • “Pseudodementia” may be seen in  depression
    • Characteristic features of dementia
      • Impaired socio-occupational functioning
      • Cognitive decline
      • Personality changes
      • Normal consciousness

 

  • Most common type of dementia is Alzheimer’s Dementia
  • Abstract thinking , Memory , Personal care are impaired in dementia

 

    • Alzheimer’s dementia,
      • More common in females
      • More common in first degree relative with the disease
      • Past history of head injury is a risk factor
      • More common in patients with Down’s syndrome
    • Irreversible causes of dementia,
      • Alzheimer’s disease
      • Multi-infarct dementia
      • Pick’s disease
    • Pick’s disease.

 

  • A form of presenile dementia
  • Occur due to atrophy of the frontal and temporal lobes.

 

      • Usually occurs between 40-60 years of age
      • It is more common in women than in men.
      • Course may take from a few months to 4-5 years to progress to complete loss of intellectual functions.
    • Corttical dementia is seen in

 

  • Amyotrophic lateral sclerosis
  • B12 deficiency
  • Dialysis

 

  • Causes of subcortical dementia are:
    • Huntington’s chorea.
    • Parkinson’s disease.
    • Wilson’s disease
    • AIDS
      • Cortical dementia may be differentiated from sub-cortical dementia by
        • Aphasia and agnosia are features characteristic of cortical dementia
        • Memory loss is more severe in cortical dementia

 

  • Motor speed and cognitive processing remain relatively

 

unaffected in cortical dementia

      • Pseudodementia can be differentiated from true dementia by
        • Short duration of symptoms
        • Nocturnal accentuation of dysfunction uncommon
        • Marked variability in performance on tasks of similar difficulty         
      • Conditions associated with amnestic disorders,

 

  • Thiamine deficiency
  • Benzodiazepines
  • Electroconvulsive Therapy

 

    • Classical clinical vignette based on antiepileptic non compliance
      • Kavya, 21 years old unmarried female is a diagnosed case of ‘grand mal seizures’, and is well controlled with 300 mg of phenytoin sodium per day in divided doses. She is brought to casuality with a fresh episode of seizure episode at 9.00 pm while she was cooking food. The first thing to do in such a case is check for compliance and precipitating factor.

 

    • Characteristic features of hysterical fits,
      • Usually occur in company of people at safe places

 

  • Injury or incontinence usually absent

 

      • Never occurs during sleep
      • Patients with hysterical fits usually try to gain attention/ sympathy, so amnesia for events does not occur.
    • Behavioral problems in epilepsy is/are due to:
      • Antiepileptic drugs
      • Psychosocial factors
      • Disease itself
    • Alzheimer’s disease is related to hypoactivity of acetylcholine in CNS:
    • “Pre-senile Dementia” occurs before age of . 65 years

 

  • Clinical picture: loss of hair, bradycardia, constipation and Depression is seen in Hypothyroidism
  • Systemic illnesses may have psychiatric manifestations

 

      • Hypothyroidism
      • Hyperthyroidism
      • Acute Intermittent Porphyria
    • The common psychiatric manifestation of hypothyroidism is depression
    • Commonest psychiatric disorder associated with AIDS is depression

 

  • Dysboulia.

 

      • Inability to fix attention

 

  • Difficulty experienced in thinking; mind weariness

 

      • Weak and uncertain willpower.

 

  • The most common psychiatric illness following Myo-cardial Infarction is depression